NEXT!

I have officially graduated! I actually graduated 2 weeks ago but I have been busy with family and and studying. Interestingly, graduating felt very anti-climactic. Maybe it's because I have so many other things to accomplish in order to practice? It was a bit sad for me to realize that I will never see some of my classmates again. We spent so much time together and shared so many unique and trying times that I feel there will always be a bond between us.

Last week I went to a review course for my certification exam. We were in "class' 13 hours a day and had a 2 hour test each evening. It was exhausting but I think it will be worth it in the long run. Tomorrow I have a 2nd interview with a family practice group - more about that later. I take the PANCE next week. I think I should pass based on my tests at the review session but I am studying a bit more between now and then just to shore up weak spots. Wish me luck and put some good vibes out there for me the morning of the 9th.

Balance?

Many readers have asked how I balanced my school work with my family life. The cut and dry answer is poorly. I went into this afraid I might fail. As a result I put 80% of free time the first year into studying, maybe more. As a result I didn't fail. I did piss off my wife considerably and my son vented the way a toddler knows how. My clinical year was really just like having a job, but without the pay or respect. I worked 6 to 15 hrs a day depending on the rotation and particulars of the day. I still had to work on my masters program but that took maybe 6 hrs a week. Things went a lot better but not having an income and thus no money to be able to buy groceries when needed or pay for car registration and having to ask my wife to do all that really continued to wear on her. I think there was slight resentment that I was able to go to school and not have to work. I feel that my wife thought PA school was fun, maybe like undergrad was for her. Other than the occasional moment here and there it was not fun. It was hard-ass work that I will be paying for for many years to come.

Balance? I did my best. Many times it wasn't good enough for the other parties involved but I HAD TO make sure that I did as well as I possibly could while I had the chance. I will graduate with a 3.8 in my PA studies and a 3.9 in my masters, which is from another school. I am still married - today is my 8th anniversary and I hope for many more. My son still loves me and likes to be with me. I'll see if any of that changes if can't get a job real soon!

Hospitalist Rotation

I am seeing a bunch of stuff I have never come across on this rotation. A sickle cell crisis, various county jail prisoners, various substance addictions, lots of chronic kidney disease, lots of uncontrolled diabetes,a gut who swallowed a bunch of pencils, lots of dialysis patients and all their complications, HIV, people from far away lands, TB and then your garden variety CHF and COPD.

I graduate in less than a month and am looking to avail to find a job. It is hard because a lot of employers want experience. Add to that the fact that I am not yet certified means no one is returning my calls/emails. Maybe once I get certified things will turn around. I am so tired of the hassle not having money has created between me and my wife. Rather, me not having any money. She makes well into 6 figures however. And never the two shall meet!

Less than a month to go!!?.....

I recently completed my orthopedics rotation at a very well respected and high profile practice. The doctor that worked with s the team doc for a pro baseball and football team. The problem was that the PA who works there and whom I know was out on vacation for the first week and a half of the rotation. This left me to whims of the surgeon and the fellow he had with him. Unfortunately, the fellow was less than interested in getting me involved and the surgeon was in a perfectionist kind of mood during my rotation. So, the few times I did get in there to hold a leg for an ACL recon or arm for a rotator cuff, I didn't know exactly what to do every minute of the case, leaving the surgeon frustrated. When the PA returned thing improved but the surgeon was still in a pissy kind of mood. So I did my thing and did it as well I could and pushed on. The PA was very apologetic for the disappointing rotation. I learned some stuff along the way, one of them being that surgery of any kind probably isn't for me.

Now I am doing a hospitalist rotation with a group of PAs and NPs in a large county hospital. It has been interesting so far. I've seen HIV, dialysis patients, traumatic brain injury patients, lots of homeless and undocumented residents, and its been fun. I am trying to improve my skills at presenting cases to the attendings. I suck at it, just plain suck.

I graduate in less than a month and am trying to complete my Master's Clinical Residency Project, do well on this last rotation, keep my wife from killing me in my sleep and find a job. I also sprinkle in studying for the PANCE when a spare-spare moment presents itself.

Getting closer

Inpatient medicine was interesting. I was too impressed with docs' desire/ability to teach but they were very knowledgeable and pretty nice. I felt like an idiot coming out of that rotation so I set up my last rotation for IP med at a different hospital.

This rotation, my second to last, is in orthopedics. Last week was boring because my PA preceptor was out on vacation so his surgeon and a fellow had me follow them around. In surgery I did little more than watch and close. Oh and on my first day in the middle of a long surgery I went to sit on a rolling stool and missed. I crashed to the floor on my ass. No one really missed a beat though. They asked me if I was OK and the the surgeon informed that I was no longer sterile. Duh. The surgeon takes care of a major league sports team which is kind of interesting I guess. I am not involved in any of that but the surgeon and his fellow are. I use to consider myself somewhat a jock, as it were, but these guys live it and work it. It is weird to see grown men so interested in a sports team that they don't even play on. Furthermore, the fellow, who has completed residency and is now doing a year in sub-specialty ortho had never removed an ingrown toenail!? These surgeons (now and in previous rotations) do such a wimpy H&P it makes me laugh. They don't even own stethoscopes!

Some folks love surgery, but I think I need more medicine to be happy. Plus standing around in an OR all day telling lame jokes or going over stupid music or history trivia is not my idea of fun. Even if I do get to drive the scopes.

moving forward

Surgery went well. I learned a lot and got pimped more than I cared for. I got t hold a lot of retractors and close up a bunch. I even got to drive the instruments on a few lap choles.

I had an ortho surgeon approach me about a job, but when the interview came I was very disappointed. none of the 6 docs or 5 PAs had read my resume, no one had set aside much if any time to talk to me so I had to wait around the MAs desk waiting for someone to come out of a room so I could talk to them for 3 minutes. When I had lunch the practice owner, he spent the first 10 minutes explaining to me why I shouldn't expect to get paid too much as a new grad and how much of a burden and investment I would be in the first year. By then I had shut down so when it came time to talk to the practice manager I was over it. She asked me if I had any questions and all I could say was "no." She asked me if I wanted to hang around and see some patients with a doc and PA and I lied and told them I had another appointment soon. What a joke.

Now I am doing hospital medicine and I was working evenings and nights, which is why I hadn't written anything here for a while. I was either working or sleeping! By the way, 8p-8a sucks!!!! I was utterly useless most of the time after 2 am and slept from 10a to 4p, further increasing my useless quotient. Furthermore I know absolutely nothing compared to the docs i am working with. The patients are so much more complex and the differentials are seemingly infinite. Or at least pretty obscure in my mind. I am feeling stupid and tired right now. At least my shift is changing now so I should only feel stupid soon.

Surgery

Surgery rotation is going well. I have been fortunate enough to have been placed with a "nice surgeon." I have a reading assignment every night that I am pimped on the next day. Fortunately, when the med students and residents are around he pimps them rather than me. While I can't answer some of his questions, neither can the MS3s or the R1 or R2s. I have been able to answer more than the MS3s for the most part and know my way around the ER better. Once they are done with their residencies they will know a lot more in their given specialty than I will I imagine.

The surgeon likes to give out nicknames to the students and residents. My nickname is the feminine version of my first name. A resident has been nicknamed Travesty and an Asian female med student was nicknamed Sushi, but not for long. Often times the male student's sexuality is called into question in a joking kind of way - usually mine. It doesn't bother me because I think that kind of stuff is so jr. high school to begin with. The surgeon likes to tell jokes in the OR and they are sometimes of a sexual or mildly vulgar nature, ss are some of the pimp questions. E.g. after a long session on the muscles and nerves of the neck, to a female med student: "What is the economic significance of the platysmus muscle?" Leave a comment if you have a guess.

Another pimp question with no innuendo attached was "how were American Indians able to kill bison with single arrow riding full speed on horseback?" Again, let me know your guesses. Most of the time in the OR I watch or cut sutures or retract but on very rare occasion to I get to first assist on surgeries, which is a lot more interesting. I helped remove a lung lobe secondary to cancer, and assist on a mastectomy as well as help the plastics guy with the first stage of breast reconstruction. We also removed a malleable retractor from a patient after it had been there 19 years - from a surgery elsewhere.

I have been working pretty hard and I am usually beat after 3 or 4 surgeries in the afternoon. It is a good experience overall, and I don't really have a with my preceptor - I am just surprised he can get away with those kinds of jokes and question given what I have witnessed in other similar situations in the business world. He treats me well and teaches a lot so I am grateful for this rotation. I may have a job lined up as an indirect result of this rotation too!